Confusable diagnoses · PANCE / PANRE

Placenta Previa vs Placental Abruption

Placenta Previa and Placental Abruption are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Placenta Previa vs Placental Abruption at a glance

  • Placenta Previa: Placenta covering or near the internal cervical os — painless bright red bleeding in second/third trimester.
  • Placental Abruption: Premature separation of the normally implanted placenta — painful bleeding with uterine hypertonus and fetal distress.
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Side-by-side comparison

FeaturePlacenta PreviaPlacental Abruption
At a glancePlacenta covering or near the internal cervical os — painless bright red bleeding in second/third trimester.Premature separation of the normally implanted placenta — painful bleeding with uterine hypertonus and fetal distress.
Classic presentationThird-trimester woman with painless bright red vaginal bleeding, soft non-tender uterus, and placenta over or near the cervical os on TVUS.; Painless bright…Third-trimester woman with painful dark vaginal bleeding, firm tender uterus, and nonreassuring fetal heart tones — especially in setting of hypertension or…
Workup / key labsAVOID digital cervical exam in any patient with third-trimester bleeding until placenta previa is excluded by ultrasound.; CBC, blood type and crossmatch,…CBC, blood type and crossmatch; Coagulation studies (PT, PTT, fibrinogen — pregnancy normal >300-400 mg/dL; <200 concerning, <150 critical); DIC panel:…
ImagingTransabdominal ultrasound first, then transvaginal ultrasound — safe in placenta previa and more accurate; gold standard for diagnosis; Routine anatomy scan…Continuous external fetal monitoring — most important assessment; Tocodynamometry — high-frequency low-amplitude contractions or hypertonus; Ultrasound —…
First-line treatmentAvoid digital cervical exam, intercourse, vaginal tampons; Activity restriction (modified — strict bedrest no longer recommended); Hemodynamic stabilization…ABCs — large-bore IV access, type and crossmatch (4-6 units), IV crystalloid resuscitation; Continuous fetal monitoring; Left lateral decubitus positioning,…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.